“He’s coming again.” The care partner passing my desk said the words as if commenting on the weather, or telling me she was going for lunch. I knew exactly what she meant.
George loved to wander in his wheelchair, and if he made it past my desk, he would create havoc in our dining room, the next stop. His love language was touch, and in his almost insatiable search for it, he would travel the halls.
I jumped up and stood in front of him, blocking his entrance to the dining area. “George! How great to see you. How are you doing?” His slightly bemused smile suggested he didn’t know this woman with the huge grin who held his hand, but she seemed like his best friend, so maybe she was. He grinned and we chatted as I guided him up the hall to his own neighbourhood. He flirted shamelessly and revelled in the connection. When we arrived, I interested him in an activity and scuttled back down the hall to my desk. I had about 10 minutes until he showed up again.
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Wandering, aggression, sundowning, paranoia: the difficulty about talking about these issues is that they are so–difficult. Care partners struggle with ways to deal with them, and suggestions may work one day and not the next.
We are talking about behaviours which are common to people with a diagnosis of some form of dementia. Some people don’t experience any, some struggle with one, two or more. They are more common later in the disease, but everyone is different.
Why do they occur?
It’s easy to say “this is common with dementia,” but many underlying reasons may be the trigger. Knowing a possible catalyst can lead to an effective intervention.
- an unmet need George wandered because he was looking for connection. Some people wander because they want to go home. Sometimes the “home” they are thinking of is the place they lived as a child. Some are looking for the bathroom.
- bodily functions The need to urinate or have a bowel movement can lead to agitation or even aggression.
- pain If a person with dementia is feeling pain, they may not understand the reason, or even know why they feel badly. Anger may be the response.
- confusion If you woke up in the morning and nothing looked familiar, would you feel anxious? Maybe paranoid when you can’t find your wallet or your purse?
- illness Urinary tract infections are incredibly common among elders. Often, they experience no symptoms, but unusual behaviours appear. Even a mild cold or other infection can lead to the same results.
- change in routine Keeping meals and other activities at the same general time helps, but sometimes that’s not possible. Appointments or family celebrations can throw everything off.
- emotional stress or boredom Feeling scared, even if the reason isn’t real, or not having any purpose or interest in anything, can lead to anxiety or depression.
- rushing Being hurried through a task is often a trigger.
- environment Keeping any kind of chaos (noise, too many visitors, even certain television dramas) to a minimum is helpful.
The first step in helping an elder with dementia through a difficult behaviour is to look at the underlying cause. When I realized that George came visiting to get some personal contact, I learned how to respectfully meet his need.
Next week: possible interventions